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APPLICATIQ ! FOR CONSTRUCT' lN PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: `J GAS J ELECTRIC _! <br />BUILDING DEPARTMENT ' <br />259-8810 <br />DEMOLITION COMBINATION <br />OWNER �dARAODRESS <br />G.v--c�;t r'�c.i��c Co¢� G <br />TENnNT 1dAILADDRE55 <br />�Cr� 12t>� 5c E�F�E <br />ARGNITECTOR�ESIGNER MAIIA�DRE55 <br />GENERFLCCNTFACTOR M�ILAD�RESS <br />�(krn 5�s-learn.s. tba.� r�- <br />IdEGMANICALWNTFACTOfl 1.1AILADDRESS <br />1 y //'! . <br />PLUTA�INGCONTRACTOR 1dNL�ODPESS <br />CONTPACT PFICE O�F /W�ORK <br />D�BE�ANDw$OUAREFOOTAGEINVOLVED <br />� BU{LDING MECHANICAL <br />PqOPO5E0 USE OF BUIL�ING / <br />i�Ill�r.a STFp �[ P.�1 lN.l1.� CC`� <br />LEGAL DESCRIPTION OF PROPERTY �SHOWN BELOVJ OR A1 TAGH TWO COPIES� <br />LOT BLOCK OF <br />PARCEITFXIp.NUMBER ���� `�_��^ <br />CONSTFUCTIONLOANLENDER.A�DRESS.TELEPHONE Nl1MPER <br />1 A�111�.n.71� irtl2rinll <br />PROJECT <br />NO. TYPE OF FIXTURE OR Il <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />1 KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGK REAF: <br />*VPE O-F �C0y115T� <br />-i�(v <br />SIZE OF BLOG. <br />�200�i.F j. <br />OCCUPANCYLOAD <br />I�Z <br />FlEASON <br />mv.�e nc <br />LOT AflEA <br />CIiY <br />sc <br />CITY <br />E� <br />CITY <br />GITY <br />C� <br />GITV <br />FEE <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE S ; <br />I <br />FIRE SPPINNLERS aE0'0 <br />NU <br />FIRE ALARM REO D <br />NU <br />FLANS�PPROVEDBY <br />o��E JM / J� <br />ZIP <br />� <br />ZIP <br />.�u <br />21P <br />ZIP <br />ZIF <br />ZIP <br />CONTACT PERSON AN� PHONE <br />PNONE <br />PHONE <br />PlIONE <br />P� <br />PHONE <br />� ! PLUN761NG U SIGN <br />//S��TATE LIC��ENSE e <br />� <br />STATE LICENSE < <br />STAiE LIGENSE a <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL [3E COMPLETED WITH WHETHER SPECIFIED HERElN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINu CONSTRUCTION OR THF <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEC BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FGR WHICIi <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RGW AND 296.200 WAC. <br />$IGNFiURE �_ • OAl—E"-""_`=� <br />NO. TYPE OF EQUIPMENT FEE <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS ' <br />VENTILATION FAN � <br />RANGEHOOD <br />W..LER HEATER ' <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />—� <br />HEAT PUMP <br />GAS PIPING � <br />EXHAUSTFAN �' <br />SIDE SETBAGN PLAN CHECK NU61pER <br />vncnNrsrte FEES ' <br />. YES . NO BUILDING <br />occ.=a•,cv r;oe�c:.u°�ccr,r,s <br />�''''`' PLUMBING <br />Z <br />BnSEhtEr+T MECHANICHL <br />'. : YES )Z NO <br />MEIGHTLRAITFTION pDD1TI0NALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX f.00E IS 3105 TOTAL <br />SUB TOTAL 5 <br />PERMIT 3 <br />TOTAL FEE 3 <br />3� <br />l� <br />0 <br />� ��C' <br />